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General NPI Number Information
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NPI Number | 1851724447
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Entity Type | Organization
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Legal Business Name | EDMONSON EYE CARE 2016
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 100 PARK PL STE 4
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City | BROWNSVILLE
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State | KY
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Zip | 42210-9036
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Country | US
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Telephone | 270-597-9571
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Fax | 270-968-0204
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Provider Business Mailing Address
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Address Line | 100 PARK PL STE 4
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City | BROWNSVILLE
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State | KY
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Zip | 42210-9036
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Country | US
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Telephone | 270-597-9571
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Fax | 270-968-0204
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. AUBREY SMITH HARLAN
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Credential | O.D.
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Telephone | 270-597-9571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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